ADVault Senior Advisor Says Gaps in Advance Care Planning Put Patients at Risk and Impede Effective End-of-Life Care
Health Care Leader Says New Approach Is Needed to Ensure That Patient Wishes Are Clear, Accessible, and Honored
Current gaps in the development and implementation of advance care planning are leading to unwanted care, unnecessary costs, and wasted resources, all of which necessitate an entirely new approach to address the issue.
“Any time care is delivered that is not concordant with a patient’s wishes, it represents a major quality gap that needs to be taken seriously and not allowed to persist,” says Richard Feifer, MD, MPH, senior advisor for ADVault. “Failure to effectively address advance care planning represents a gap in care that is just as serious as unmonitored diabetes or an inappropriately treated asthma. Closing these gaps in care, by ensuring patients receive care concordant with their wishes, requires just as much system redesign and focus.”
According to Feifer, one of the root causes of nonconcordant care is the lack of effective and sufficient advance care planning by the care team, often due to inadequate outreach and engagement of the patient and family. Contributing to the problem is a lack of effective transmission of existing advance care plans across different parts of the health care system, particularly involving transitions of care. “The primary problem is not bad intent,” he says, “but rather our historically fragmented health care system that is reactive to acute situations and insufficiently proactive to prepare for future situations.”
A board-certified internist with extensive experience in primary care, geriatrics, and urgent care medicine, Feifer is a past president of Genesis Physician Services as well as former executive vice president and chief medical officer at Genesis HealthCare, the nation's largest skilled nursing and long term care provider. At ADVault, the nation’s leader in digital advance care planning, Feifer remains dedicated to optimizing population health and improving the quality and efficiency of health care. High on that list is the recognition of the importance of advance care planning and the critical role providers should play.
“Advance care planning has not historically been a priority during the training of clinicians so a knowledge and skill gap may very well exist,” Feifer says. “Providers can perform a great service by encouraging their seriously ill patients to complete an advance directive so clinicians at point-of-care will know what the patient wants, even if they are unable to speak for themselves. And because advance care planning often requires multiple conversations over a period of time—built on a trusting relationship and a common understanding of the patient’s prognosis—primary care providers are ideally suited to integrate advance care planning into their patient encounters.”
While the development of advance care plans is crucial, Feifer says even the best plans are completely useless if they are not available the moment they are needed. “These are often very intense and emotionally charged situations, sometimes requiring rapid decision-making,” he says. As such, Feifer strongly recommends people ensure their advance care planning documents are securely and seamlessly available electronically to hospitals and doctors across the continuum of care, 24 hours a day, seven days a week. They can do this by going to mydirectives.com, a free service that guides individuals through the process of creating an advance care plan or uploading an existing advance directive document they already have. MyDirectives also securely stores portable medical orders like DNR orders and POLST forms.
“Providing care that is inconsistent with the patient’s wishes and goals or failing to provide care the patient may desire is not only bad medicine but also creates a major regulatory, compliance and legal risk,” Feifer says. “The solution is for people to have an opportunity to engage in meaningful advance care planning conversations with their trusted health care providers, for them to complete advance directives reflecting their wishes and preferences, and for all clinicians to learn how to honor them whenever possible.”